GUT REVIEWER

• The following are terms to know in relation to the genitourinary system:

Terms to Know

• Dysuria: Pain while urinating
• Nocturia: Excessive urination at night
• Hematuria: Bloody urine
• Incontinence: Involuntary voiding
• Proteinuria: Abnormal amounts of protein in the blood
• Oliguria: Urine output of less than 400mL/day
• Anuria: Urine output of less than 50mL/day

Genitourinary System Components

• Kidneys
• Ureters
• Bladder
• Urethra
• Genital organs
• The right kidney sits slightly lower than the left within the body

Kidney Functions

• Urine formation
• Excretion of waste products
• Regulation of electrolytes
• Regulation of acid-base balance
• Control of water balance
• Control of blood pressure
• Regulation of red blood cell production (ERYTHROPOIETIN)
• Synthesis of vitamin D
• Regulation of calcium and phosphorus

Nephron

• The nephron is the functional unit of the kidneys.
• There are about a million filtering units in each kidney.
• Each nephron has a filtering structure- glomerulus and the tubule.
• The glomerulus filters the blood.
• The Bowman's capsule collects the filtrate from the glomerulus.
• The tubule returns needed substances to the blood and removes wastes.

Nephron: The Functions

• Filtration: filtering the blood
• Reabsorption: reabsorbing water, chloride, and glucose
• Excretion: excreting potassium, urea, and creatinine

Urine Formation Steps

• Glomerular Filtration: Transfer of water and waste from blood to the glomerulus
• Reabsorption: Transferring necessary contents such as ions and water back to the blood
• Excretion: Transferring excess substances and wastes to urine

Renin-Angiotensin-Aldosterone System (RAAS)

• Stimulus: Decreased blood pressure/volume or decreased sodium levels in the kidney
• Renin is released by juxtaglomerular cells in the kidneys.
• Renin converts angiotensinogen to angiotensin I.
• Angiotensin I is converted into Angiotensin II by angiotensin-converting enzyme (ACE) in the lungs.
• Angiotensin II causes vasoconstriction
• Angiotensin II promotes the release of aldosterone and ADH
• Angiotensin II promotes thirst
• Aldosterone increases the reabsorption of sodium and ions, leading to sodium and water retention, which increases blood volume and blood pressure.

The Genito-Urinary System: Kidneys

• Regulate acid-base balance, blood pressure, and electrolytes.
• Responsible for RBC production and the production of prostaglandins.
• Eliminate waste products
• Produce urine

The Genito-Urinary System: Ureters

• Transport urine from kidneys to bladder

The Genito-Urinary System: Bladder

• Reservoir of urine

The Genito-Urinary System: Urethra

• Passageway of urine

Urine Characteristics

• Color: Light yellow
• Clarity: Clear
• Odor: Mild aromatic
• pH: 4.6 to 8.0
• Specific Gravity: 1.010 to 1.030 is normal
• Protein: No protein
• Glucose: No glucose
• Ketones: No ketones
• Bilirubin: No bilirubin
• Urobilinogen: Normal levels range from 0.2 to 1.0 mg/dL

Normal Values to Remember: Creatinine Clearance

• Used
• Serum Creatinine
• BUN
• GFR
• Urine Specific Gravity

The normal GFR

• 125mL/min

The normal urine specific gravity

• 1.010-1.030

Normal BUN levels

• The normal is 10-20 mg/dl.

Serum Creatinine & Creatinine Clearance

• Purpose: Assess kidney function
• Nursing Alert: Watch for significant changes and medication adjustments.

Serum Creatinine

• Reflects the filtering and excretion capacity of the kidneys.
• Normal: 0.5 to 1.5 mg/dL
• Specimen: Blood
• Fast overnight.
• Avoid eating meat and creatinine supplements before the test.

Creatinine Clearance

• Reflects how well the kidneys filter creatinine.
• Normal: 77 to 160 mL/min/BSA
• Specimen: 24-hour urine

Albumin/Creatinine Ratio

• Purpose: To detect albumin in relation to the amount of creatinine in the urine.
• Nursing Alert: There should be little or no albumin in the urine
• Men: less than 17 mg/g
• Women: less than 25 mg/g

24-hour Urine Specimen for Creatinine Clearance

• The nurse provides instructions for a 24-hour urine collection
• Urinate at the stop time
• Use the plastic cup for each urine collected
• Pour the urine into the collection container
• Keep the urine refrigerated

Urinalysis

• Purpose: To screen medical conditions
• Nursing Alert: Proper collection and delivery, infection control

Data indicates:

• Urine output of less than 30 mL/hr: Decreased urinary output
• Urine specific gravity of less than 1.010: Fluid volume excess
• Urine specific gravity of more than 1.030: Fluid volume deficit
• Distended neck vein: Impaired cardiac output.
• Generalized edema: Fluid volume excess.
• Urine-specific gravity of more than 1.030: Fluid volume deficit

Urine Culture and Sensitivity

• Purpose: identify presence of pathogenic microorganism and determine most effective medication
• Nursing alert: proper collection and prevent infection
• KUB and IVP
• Purpose: Assess urinary tract & surrounding structures
• Nursing Alert: Preparation

KUB

• Plain X-Ray
• No consent required

IVP

• X-Ray with contrast medium
• Consent is required
• Requires cleansing enema before the test
• Assess for allergy

Biopsy

• A biopsy of an organ needs proper positioning and prevention of severe bleeding.
• Always put the CLIENT in the RIGHT POSITION before the procedure.
• Lying on their stomach (prone) or on their side (lateral decubitus position) for Kidney Biopsy
• For prostate biopsy lying on their back.
• Remain still and stay in this position for about 30 minutes.
• After the procedure: supine for 24 hours

Cone Biopsy

• Slight spotting within a month after cervical cone biopsy is expected and not reportable.
• Bleeding is normal up to 4 weeks for Cone Biopsy
• The patient should be on a table and place the feet in stirrups to position the pelvis

Common procedures

• Cystoscopy
• Cystourethrogram
• Cystometrogram

Diagnostic Tests

• Cystoscopy: Visualization of the urinary bladder
• Cystourethrogram: Infusion of fluids to determine patency of the urethra
• Cystometrogram: Infusion of various amounts of saline into the bladder to determine bladder capacity
• The catheterization process is a sterile process.

Catheterization

Before Beginning

• Explain the process to the client before beginning.
• Most clients are not used to inserting any object, let alone a long tube, into their urethra.
• Explaining the steps and what to expect can also help the client relax and avoid anxiety.
• Ask the client to lie on his or her back.
• The client's legs should be spread and his or her feet should be together.
• Lying in a supine position relaxes the bladder and urethra, facilitating easier catheter insertion.
• A tense urethra compresses the catheter, which results in resistance during insertion, causing pain and sometimes even damage to the underlying tissue of the urethra.
• In severe cases, this may cause bleeding.
• Wash hands and put on sterile gloves.
• Sterile gloves help ensure that bacteria are not introduced into the urethra and that the client's bodily fluids do not come into contact with your hands.

Preparation

• Open the catheter assembly.
• Ensure you have the correct catheter for your purposes, with the correct size.
• Sizes are rated in units called French (1 French = 1/3 mm) and are available in sizes from 12 (small) to 48 (large) French.
• Smaller catheters are usually better for the client's comfort, but larger catheters may be necessary to drain thick urine or to ensure the catheter stays in place.
• Some catheters also have specialized tips that allow them to serve different functions.
• For instance, a type of catheter called a Foley catheter is usually used for draining urine because it includes a balloon attachment which can be inflated to secure the catheter behind the bladder neck.
• Sterilize and prepare the client's genital area.
• Scrub the client's genital area with disinfectant-soaked cotton swabs.
• Rinse or scrub the area with sterile water or alcohol to remove any debris.
• Wash from inside to outside.

Catheter Insertion

• Apply lubricant to the tip of the catheter to the ⅔ portion
• If the client is female, hold the labia open and insert the catheter into the urethral meatus.
• Hold the catheter in your dominant hand and use your non-dominant hand to spread the client's labia so that you are able to see the urethral opening.
• Gently insert the tip of the catheter into the urethra.
• If the client is male, hold the penis and insert the catheter into the urethral opening.
• Hold the penis in your non-dominant hand and gently pull upward, perpendicular to the client's body.
• Insert the tip of the catheter into the client's urethra with your dominant hand.
• Continue pushing until the catheter sits in the bladder.

Balloon Catheter

• The length of the catheter should be gently fed through the urethra and into the bladder until urine is observed.
• After urine begins to flow, continue to push the catheter into the bladder another 2 inches to make sure the catheter is against the neck of the bladder. If using a balloon catheter, inflate the balloon with sterile water.
• Use a water-filled syringe to inflate the balloon via sterile tubing connected to the catheter. Usually, about 10 cc of water is required, but check the size of your balloon to be sure.

Finishing The Process

• Connect the catheter to the drainage bag, using sterile medical tubing to allow urine to drain into a drainage bag.
• Secure the catheter to the client's thigh or abdomen with tape and make sure you place the drainage bag lower than the client's bladder.
• Catheters work via gravity - urine can't drain "uphill."
• For males, secure the catheter on the lower abdomen.
• For females, secure the catheter on the inner thigh.
• In a medical environment, catheters can be left in for as long as 12 weeks before being changed, though they are often removed much earlier, some catheters are removed immediately after urine stops flowing. Specimens for culturing should NOT be cultured from urine bags, as they are not sterile.

Collecting a Sterile Urine Specimen

• Collect the urine from either
  • Urine from a newly-inserted catheter, placed with
    • Directly into specimen container provided in urinary catheter insertion kit.
    • Urine from indwelling catheter.
      • Catheter tubing is clamped below the aspiration port so that urine collects in the tubing.

Diagnostic Tests

• Urine for culture and sensitivity
• Clean catch
• Suprapubic aspiration
• Catheterization
• Bacterial colony count is more than 100,000/mL is a Positive Test
• Proteinuria may also be present indicating presence of bacteria

Catheter Collection Specimen

• Catheter Collection Specimen - This assisted procedure is conducted when a patient is bedridden or cannot urinate independently.
• The healthcare provider inserts a Foley catheter to collect the sample the following methods

Suprapubic Aspiration Specimen

• This method is used when a bedridden patient cannot be catheterized or a sterile specimen is required.
• The urine specimen is collected by needle aspiration through the abdominal wall into the bladder.

Collection of Urine Specimens

• Improper collection may invalidate the results
• Containers to collect urine should be wide-mouthed, cleaned, and dry
• Specimen must be analyzed within 2 hours of collection, or else requires refrigeration

Potassium

• Potassium is primarily excreted by the kidneys so hyperkalemia means renal excretion is not happening and is an indication for dialysis.
• Peritonitis, manifested by abdominal rigidity is a complication of peritoneal dialysis.

Peritoneal Dialysis

• Fresh dialysis solution bag is hung and attached through the catheter to insert the solution into the abdomen to absorb waste products and excess fluid
• Waste fluid is drained into a disposable bag
• A nurse needs to have and know the difference between Standard Tenckhoff, Swan-neck catheter, Coil catheter

Hemodialysis Process

• The machine filters contaminated blood and returns clean blood to the body
• An AV shunt is needed for a client undergoing hemodialysis until the AV fistula matures.
• The patient needs to be evaluated before using the dialysis machine

Renal

• A client with renal failure should be on a low protein diet to minimize metabolic waste products, and a client on hemodialysis should be on a diet high in protein to replace protein loss during the dialyses procedure
• Disequilibrium syndrome, manifested by headache and vomiting is a complication of hemodialysis
• Complications include Disequilibrium Syndrome, Cerebral edema, Restlessness, Nausea & vomiting, Headache, Hypertension, Slurred speech, Seizure Coma
• Dialysis encephalopathy, Syndrome, observed in chronic renal insufficiencyclients on dialysis, Dementia, Astericis, Myoclonias, and Convulsions

Ray A. Gapuz's

• Glucose in the urine of a pregnant client is normal.
• Poor bladder control is expected on an elderly client.
• Frequent urination in pediatric clients is normal.

Assessment findings indicate

• Ecchymoses in the flank area: Retroperitoneal bleeding
• Severe colicky pain : Renal calculi
• Hematuria : AGN
• Common risk factors for genitourinary disorders include:
• Wearing silk underpants: UTI
• History of UTI: PID
• Sore throat: AGN
• History of hypertension: AAA
• Vaginitis is a general term used to describe inflammation or irritation of vagina characterized by itching, irritation and discomfort.
• Bacterial Vaginosis: Thin off-white with fishy odor
• Trichomoniasis: Thin yellow green malodorous frothy discharge
• Candidiasis: Thick cottage cheese
• Having uncontrolled diabetes and STI increase risk of developing vaginitis Vaginitis can be related to Candidiasis, Moniliasis, Trichomoniasis and other irritants
• Bacterial vaginosis has Amsel criteria as diagnostic
• Candidiasis has a microscopic examination using KOH
• Trichomoniasis will used a wet mount microscopy, culture, NAAT
• Atrophic vaginitis uses a clinical assessment
• Chemical irritation will used clinical assessment

Vaginitis: Type | Cause | Clinical Manifestation

• Bacterial Vaginosis: -- Cause: Gardnerella vaginalis -- Manifestation: Foul-smelling discharge

• Candidiasis (Yeast Infection): -- Cause: Candida albicans -- Manifestation: Thick, white, cottage cheese-like discharge

• Trichomoniasis: -- Cause: Protozoan parasite Trichomonas vaginalis -- Manifestation: Frothy, greenish-yellow vaginal discharge

• Atrophic Vaginitis: -- Cause: Thinning, inflammation vaginal walls due to hormonal changes (estrogen) -- Manifestation: Vaginal dryness, burning, itching

• Chemical Irritation: -- Cause: Irritants exposure (soaps, detergent, perfume, spermicide) -- Manifestation: Inflammation, discomfort

Vaginitis: Type | Diagnostic Test | First-Line Treatment

• Bacterial Vaginosis: -- Test: Amsel Criteria -- Treatment: Antibiotics like Metronidazole or Clindamycin

• Candidiasis (Yeast Infection): -- Test: Microscopic Examination using KOH -- Treatment: Anti-fugal (Clotrimazole orFluconazole)

• Trichomoniasis: -- Test: Wet Mount Microscopy, Culture, NAAT -- Treatment: Metronidazole, Tinidazole

• Atrophic Vaginitis: -- Test: Clinical Assessment -- Treatment: Hormone Replacement Therapy (estrogen)

• Chemical Irritation: -- Test: Clinical Assessment -- Treatment: Removal of irritant & Symptomatic Relief, like sitz bath or cool compress.

Endometriosis

• Endometriosis is the proliferation of uterine tissued outside the uterus
• Related causes: Genetic factors, Dysfunction of Immune System, Hormonal Factors, Inflammation and Angiogenesis
• Signs & Symptoms : -- Pelvic pain before menstruation -- Infertility -- Diarrhea/Constipation -- Low back pain -- Irregular menstruation -- Blood in the urine

Endometriosis

• Diagnostic examinations: Ultrasound & laparoscopy
• Priority Nursing Diagnosis is pain.
• Comfort, as prescribed, with NSAIDS
• Oral contraceptive pill
• Possible surgery

Inflammation of Prostate

• Prostatitis is the most common prostate problem in men under the age of 50
• inflammation as defense but can cause tissue damage within the prostate
• Common signs and symptoms Prostate Gland Inflammation is Pain in lower abdomen or pelvic region
• Swollen, tender, painful prostate
• Digital Rectal Examination

####Prostatitis vs BPH

• First-line treatment is antibiotics, alpha-blockers, and pain medications
• Acupuncture can be a treatment for prostatitis
• High fever + weak urine stream indicates Acute Bacterial Prostatitis
• Pain in the penis with a Scrotum of more than 3 months indicates Chronic Prostatitis, or a Chronic Pelvic pain Syndrome
• Functional Concept: Asymptomatic prostatitis=inflammation of the prostate, no symptoms.
• Functional Concept, prostatitis can lead to : Infertility, sepsis and death. BPH is enlargement of the prostrate gland, leading to the narrowing of the urethral opening

BPH Specific causes: -- Testosterone Converted to DHT -- Cellular Change -- Inflammation Symptoms -- Decreased Urine Stream nocturia, incontinence, dribbling,urine retention,blood in the urine

• Treatment = alpha blockers & Surgical management

Surgical management for BPH include: -- TURP - transurethral resection of the prostate -- TUIP - transurethral Incision of the prostate -- TUMT - transurethral Microwave thermotherapy -- TUNA - transurethral Needle Ablation

Turp Procedure :

• Instrument : Resectoscope w wire to cut away Excess prostate removed will then be flush with with special fluid Complications : Infection BPH = factors that affect the urethra stream and rectal function

• Weak urine stream = both Prostatitis and BPH

• High Fever = acute bacterial prostatitis- not BPH

Focusing

• Inflammation in the urinary bladder is called Cystitis
• Cystitis is caused by an ascending bacterial infection (E. coli) In the body this results inInflammatory Infiltration & Tissue Damage

Cystitis

• Fever & Flank Point are common factors in Cystitis

Treatments

-- Co-trimoxazole- Drug of Choice -- Culture and Sensitivity to test for e.coli

Matrix MR- Diagnostic test

• • Cystitis -- URETHRITIS -- PYELONEPHRITIS -- ACUTE GLOMERULONEPHRITIS
• Functional Concept

Acute Glomerulonephritis;

• Acute Glomerulonephritis is treated using antibiotics is caused a Bacterial infection
• Acute Glomerulonephritis: Cause: GABHS, Hx:strep thorat,scarlett fever A low-protein diet and Edema Management should be provided to help with sever cases
• Edema Management: Consists of Fluid Restrictions Functional Concept, Pain management,analgeics,Medical Expulsion therapy or Increase fluid intake, diet changes Functional Concept Medical Expulsion Therapy- relax to pass Stones,increase fluid intake,deitary changes
• Medication to prevent the use of Thiazide Diaretics

Acute Glomerulonephritis

• Treat the Underying Cause

Acutre Glomerulonephritis

• treat with antibiotics, and manage the symptoms or related symptoms Treatments Antibiotics- for infections, Blood pressure to promote and to reduce protein level in the blood Medications : ace and arbs,diuretcs

Functional Content- The Presence of Excess Stone

Renal

• The Renal and GUT Disorders:

The three main points for testing ++Improper collection - may invalidate the results ++Urinary testing ++ Renal Functions

NEPHROTIS VS NEPHRITIC:

++Diabetes , NSADIS,Antibiotics- are the cause

NEPHROTIC AND NEPRHITIC

++Diasese has several different effects and traits

For the Diseases.

• Alport Syndrome
• Low Na; Low chon

###Functional Concept There’s no Cure, just manage: bp, Protienaria, Hearing, support: 1 management: 4 Alport syndrime is characterixed by Hemorrhagis,Sensorinueral hearing loss, Eye

• Alport syndrome is manafested by hematuria,protienuria,hyper

For Renel patients

• Low Na, Hi Chon To replece Protien loss

For Acid & Alkaline

++ Goal: to Reduce and dilute urine +Acidet = Alkelize the blood Avoid: Spinch, stwaberries and so forth

ALPORT SYNDROME Genetic Mutation: Abnormal collagen production (IV) X-linked Dominant Abnormal GBM prone to damage & disruption → glomerular dysfunction and scarring FUNCTIONAL CONCEPT +sudden +affect: Brain, heart and Lungs (renal)

tests include a check, or to test and evaluate if the person has had the same results

Kidney Diseases:

• Medictions
• increase oral fluid intake, Avoid things.

Kidney Disease:

+decrease NA , fluid

Fuction -to improve kidneys health 1 identify

++The goal of kidney transplant is the to ELIMINATE cause of kidney Fariure and revser them

Alport is best treated with Kidney Transplant Aki- high and test with creatinine

Nephrotic syndrome is non- ifflamatory dambage to the kindeys

Things you should remember:

For drugs:

++ Aldactione-hyper kaleima, Lass 9x- Hipo kaleima

things to aviod

++Avoid Grapfruit Juices

Common Cuse +Hic and so forth

For Spirdoloacetone- you give you may have a Potassium Increase Aluminimum hydroixide gel test may have white stools- avoid Black, Tarry stool. Chlorothiazide Diuril- adimitsterd and use as a common Sude effects

FUROSEMIDE LASIX

• Side effects: headeach +Monitor- electrolytees Astringents monitor for electrolytes or give